Eating disorders such as anorexia nervosa and bulimia nervosa have been recognized for hundreds of years, while binge eating disorder, in comparison, has only recently been categorized as a specific disorder. Health professionals have made great strides in recent years understanding this particular condition and how it affects each individual. Binge eating disorder treatment has also come a long way during this time to help individuals on their path to recovery.
In understanding the history of binge eating it is important to distinguish this condition from other types of eating disorders, such as bulimia nervosa. While both binge eating disorder and bulimia nervosa involve consuming large amounts of food at irregular intervals, there are distinct differences. In particular, those with bulimia nervosa may engage in purging that often includes self-induced vomiting, laxative use or excessive exercise. Binge eating disorder does not normally include these types of compensatory measures after eating. While binge eating disorder is a relatively new condition in comparison to other eating disorders, the last 60 years has seen rapid changes in attitudes and treatment methods.
Binge eating disorder was first recognized in 1959 in a paper written by psychiatrist Albert Stunkard. He described the disorder as an eating pattern that involved consuming an excessive amount of food at irregular times. At the time, he associated eating episodes with night eating. Eventually, the term “binge eating” was used whether excessive eating occurred during the day or night.
Prior to the 1950s, binge eating would not have been something the average person could easily engage in even if they had a tendency or a desire to do so. Eating large quantities of food at one time meant having the money or means to obtain what would equate to several meals at one time. Most people were not able to obtain enough food to engage in this particular disorder. As the standard of living increased in Western societies and the availability of large amounts of food produced cheaply increased, so did the incidence of bulimia nervosa and binge eating disorder.
Cognitive Behavior Therapy (CBT) was started by Dr. Aaron T. Beck in the 1960s. Dr. Beck realized his patients had an internal dialogue, or thoughts, that affected their feelings. CBT has since become a type of therapy used to treat a variety of conditions including eating disorders. CBT is still considered one of the primary binge eating disorder treatment methods. Even though binge eating disorder was not officially classified at this time, many physicians had begun to prescribe stimulants to help individuals who were obese.
While not every person that was overweight had BED, there were likely individuals that had this disorder who may have experienced some relief when prescribed stimulants. Stimulants can suppress the appetite and work by increasing noradrenaline and dopamine in the brain. Since bingeing and excessive eating may be related to these systems in the brain, stimulants may have provided benefits for individuals with undiagnosed binge eating disorder. It should be noted that stimulates such as Concerta, Ritalin and Adderall have not been FDA approved for binge eating disorder.
During the 1970s there was a rapid increase in eating disorders. There were likely several reasons for the increase during this time period. During the 1970s and early 80s, there was an increased cultural focus on being thin as well as the rise of the supermodel phenomenon. The ideal body image for women was increasingly becoming thinner. Ironically, obesity rates also began to rise during this time period and there was a greater focus on low-fat eating plans and weight management. While Karen Carpenter had been diagnosed with anorexia nervosa, her struggle brought much-needed attention to a variety of eating disorders.
It wasn’t until 1987 that the American Psychiatric Association (APA) mentioned BED in its Diagnostic and Statistical Manual of Mental Disorders (DSM). Even at this time, the disorder was listed as a feature of bulimia nervosa. By the 1980s attitudes regarding eating disorders began to change. Celebrities, such as Princess Diana, began to speak out about the eating disorders they had experienced. Many college campuses began providing counseling for students with different types of eating disorders.
The 1990s saw great advancements in the treatment of binge eating disorder. In the early part of the 1990s, Dialectical Behavior Therapy was introduced by Dr. Marsha Linehan. It is considered to be a type of behavioral therapy. Dialectical Behavior Therapy focuses on identifying and changing negative thought patterns. It is important during therapy to find both acceptance and change to achieve positive results. Dialectical Behavior Therapy is still used in the treatment of binge eating disorder.
In 1993 a Cognitive Behavioral Therapy manual was published by Fairburn, Marcus and Wilson that went on to become the most studied manual of its kind. This particular manual described how Cognitive Behavioral Therapy could effectively be used to treat anorexia nervosa, bulimia nervosa and binge eating disorder. It discussed how treatment could be adapted to suit the individual needs of each patient.
Many different types of serotonin inhibitors were initially released during the 1990s. These medications are primarily prescribed to treat depression and anxiety. They have also been shown to be effective when treating obsessive-compulsive disorder (OCD) as well as impulsive types of behavior. Eventually, medical professionals began prescribing them to treat behaviors and impulses associated with binge eating disorder. These medications became a treatment option for co-occurring conditions, such as depression or anxiety. Selective serotonin reuptake inhibitors have been found to successfully help treat behaviors and impulses sometimes associated with binge eating disorder. The following are several types of selective serotonin reuptake inhibitors that are sometimes used to treat binge eating disorder.
- Paxil: This medication was released in 1992.
- Zoloft: This was released in 1992 for depression, in 1996 for OCD and eventually used for binge eating disorder.
- Luvox: Luvox was released in 1994.
- Celexa: This drug was first released in Denmark in 1989 under the name Cipramil and then became available in the United States in 1998.
In 1994 BED was included in the DSM-4. The American Psychiatric Association specifically mentions binge eating disorder. It is, however, categorized as an Eating Disorder Not Otherwise Specified (EDNOS). While binge eating disorder treatment was in its infancy, the fact that it was now being mentioned by a professional association was a major step toward helping individuals with this particular disorder.
The National Eating Disorder Association was formed in 2001. This is the largest nonprofit group that provides support to families and individuals with a variety of eating disorders. During this time greater emphasis was placed on holistic types of treatment. Health professionals begin to view the whole person instead of just focusing on the eating disorder. The best treatment was starting to look at an individual from varying perspectives. This included the spiritual, mental, emotional and physical aspects of each person. Treatment also increasingly focused on the entire family instead of just treating the person individually.
During this time there were a variety of excellent eating disorder resources and organizations formed to provide education and support for those who had eating disorders. The Binge Eating Disorder Association (BEDA) was formed in 2008. This association is a national organization that focuses on the diagnosis, prevention and treatment for binge eating disorder. BEDA’s membership consists of both individuals and those providing professional treatment. In 2008 the National Institutes of Health stated that milnacipran was effective in the treatment of binge eating. This particular medication showed improvement in individuals after eight weeks of use.
In 2013, BED was formally recognized in the DSM-5. This was the first time binge eating disorder was acknowledged as a separate disorder from other types of eating disorders. This was a major step toward helping people get the help they needed. Individuals could now receive binge eating disorder treatment covered by insurance. Prior to this many health professionals only recognized binge eating as something that was specifically associated with obesity, and not a separate and distinct disorder.
During this time the National Institute of Health published a report regarding studies that have highlighted the different eating behaviors in those who have eating disorders and how these behaviors are different from those who do not have these types of conditions. A detailed understanding of these differences has helped medical professionals better understand the diagnosis and provide more effective interventions and treatments.
In 2015 the Food and Drug Administration (FDA) approves of a new drug for treating binge eating disorder. The drug, lisdexamfetamine dimesylate, was sold under the name Vyvanse. This particular medication was prescribed for the treatment of moderate to severe binge eating. It had previously been used in the treatment of ADHD. This medication is absorbed rapidly from the intestinal tract and then converted to dextroamphetamine. One way it may help individuals control binge eating is by keeping a steady supply of the neurotransmitter dopamine in the brain. Overeating, as well as binging, may be linked to the reward centers in the brain.
This was an enormous step in the treatment of BED since it was the first drug that was specifically used for this disorder. The prior developments that made professionals aware there was a difference between BED and obesity may have helped researchers create an effective medication for this disorder. It is important to note that Vyvanse might not be the best option for all individuals, particularly those who have co-occurring substance abuse behaviors. This is because of the potential of addiction when taking Vyvanse.
Researchers and medical professionals are still learning how BED affects different people and the best treatment options for each individual. Binge eating disorder treatment has advanced significantly since the disorder was first recognized in 1959. Treatment is now psychologically gentle and provides the highest level of care outside of a hospital setting that is available. Thorough medical and psychiatric management means individuals can go on to live full and successful lives after treatment. Researchers are currently looking for ways to develop treatment plans that include both the psychological and physical aspect of binge eating.
Oliver-Pyatt Centers offers individuals a customized treatment plan in an intimate and comfortable environment. They provide high-frequency psychotherapy, daily interaction with a medical team and supported exposure therapy that includes guided outings into the community. The offer residential and day treatment as well as supervised living. Contact Oliver-Pyatt Centers for more information.